It is very common for breastfeeding newborns to develop jaundice, the yellowing of the skin and mucous membranes, in the days or weeks after birth. Jaundice can become a serious health problem for babies, and it is important to get familiar with the situations related to breastfeeding that can cause a baby to get excess bilirubin levels in the blood.

What is jaundice exactly?

Before they are born, babies have more red blood cells in their blood. This helps them get oxygen from their mother, which is passed to them through the placenta. Immediately after birth, babies begin to breathe on their own and no longer need all those red blood cells. They must somehow be eliminated. Bilirubin, the by-product of the breakdown of these blood cells, is eliminated through the liver, which gets it into the baby’s digestive tract and from there into their stool. However, the baby’s liver is immature and cannot work as fast. Therefore, bilirubin accumulates in their skin, mucous membranes, and the white part of the eyes.

Do all babies get jaundice?

Practically half of all newborns suffer jaundice to one degree or another. What has to be assessed is when it occurs in order to be able to determine whether it is physiologic (normal) or abnormal (pathologic). Pathological jaundice appears in the first hours of life and is associated with infection or Rh incompatibility. This requires urgent measures.

Physiological jaundice is not a disease and may be related to low breast milk intake (breast milk deficiency jaundice) or to breast milk intake (breast milk jaundice).

What is pathological jaundice, and how does it appear?

This jaundice appears during the first hours of the baby’s life and is not related to feeding. It affects approximately 6% of babies and is related to severe infections, Rh incompatibility, lack of oxygen at birth, hemorrhages, various syndromes, and other complications. Although the baby will need immediate and adequate medical attention, the baby’s nourishment can be breast milk.

What about physiologic jaundice?

Physiological jaundice can be divided into two types depending on when it appears.

When it appears from the second to the third day of life:

This type of jaundice affects 50% of children born at term and 80% of premature babies. It is more common in certain ethnic groups: Chinese, Japanese, Koreans, and South Americans. It begins to manifest on the second or third day of life (with bilirubin values between 12-15 mg/dl), and after the fourth day of life, it begins to decrease. It is caused by poor breastfeeding initiation or insufficient breast milk intake.

• In this case, the frequency of feedings at the breast must be increased by waking the baby if necessary. If the baby does not latch on to the breast or is very sleepy, supplementing with expressed breast milk, donor human milk, or formula helps the baby to pass more stools and eliminate bilirubin.
• If the jaundice does not decrease or increases, help the baby to eliminate bilirubin with phototherapy treatment. It is not necessary to stop breastfeeding, and if possible, mother and baby should remain together in this case.

When it appears from the ninth day after birth

This jaundice appears during the second week of life and may last until the baby is 1 to 2 months old. It affects a very small percentage of babies (between 2% and 33%).

It is not clear why this happens, but it seems that human milk contains a hormone, a product of the breakdown of progesterone, which stimulates the intestinal reabsorption of bilirubin. This fact offers protection to the baby as it is an antioxidant.

What about exposing the baby to sunlight?

In some cases, it is unnecessary; in others, it is not advisable, even though this is a common outdated recommendation.

If the cause of jaundice is a disease, it should be treated; if the cause is low milk intake, then more milk needs to be offered to the baby, either by breastfeeding more frequently and performing breast compressions or by supplementing.

Putting a newborn baby in direct sunlight to treat jaundice does not work because the “amount” of sunlight needed is dangerous for babies.